Preoperatively diagnosed mucocele of the appendix.

Mucocele of the appendix is an infrequent entity, characterized by distension of the lumen due to accumulation of mucoid substance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and the histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadeno carcinoma. In this paper, we report a case of an asymptomatic 37-year-old woman in whom mucocele was found on a routine ultrasound examination and preoperative computed tomography scan. Surgery revealed a big appendix measuring 84 mm in length and 40 mm in diameter. The final pathologic diagnosis was simple mucocele.

Spontaneous diaphragmatic rupture: case report and literature review.

Spontaneous diaphragm rupture is extremely rare. Usually a diaphragm rupture is trauma induced. We describe a case of an 18-year old patient admitted 2 hours after onset, presenting severe epigastric and left sided chest pain without any trauma history. Upright chest x-ray revealed displaced stomach and colon into the left pleural cavity with a collapsed left lung. Surgery for a left-sided diaphragm rupture with stomach, spleen and colon splenic flexure herniation was undertaken. We present a brief review regarding the aetiology, diagnostic and treatment policy of spontaneous diaphragmatic rupture.

Duodenal gastrointestinal stromal tumor.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are low-grade malignant tumors that may arise anywhere in the alimentary tract, and in the past, most of them were diagnosed as intestinal leiomyoma or leiomyosarcoma. GISTs of the duodenum make up only 4.5% of all GISTs. MATERIALS AND METHODS: We report a patient presented with upper GI bleeding who exhibited radiological findings of a tumor in the third portion of the duodenum. The patient underwent a segmental duodenectomy. Pathological examination concluded in a GIST. RESULTS: The patient is free of recurrence for one year after surgery. CONCLUSIONS: Our case report, along with other, highlights that surgical resection remains the cornerstone of treatment for patients with localized disease. Along with others, we agree that from oncologic point of view, partial resection of the duodenum is an alternative to a duodenopancreatectomy.

Pseudomyxoma peritonei presenting with inguinal hernia.

Pseudomyxoma peritonei (PMP) is rare being characterized by intraperitoneal accumulation of mucinous ascites produced by neoplastic cells, mostly originating from a perforated appendiceal adenoma. The clinical signs of the disease are variable, and preoperative diagnosis is often difficult. We describe the clinical case of a 67-year-old patient referred to our unit one month after a left inguinal hernia repair, presenting clinical signs compliant with PMP. Surgical cytoreduction, peritonectomy, appendectomy, and greater omentectomy with perioperative intraperitoneal chemotherapy were performed. The patient was disease free for a 15 month period when he died apparently due to a cardiac event. We advocate that in all cases of gelatinous fluid in a hernia sac PMP must be suspected, thus histological investigation is mandatory as well as abdominal computed tomography (CT) in order to confirm the diagnosis.

[Iliac venous aneurysm: a case report and review of literature]. / Anevrism al venei iliace comune drepte: prezentare de caz si revista literaturii.

Primary iliac vein aneurisms are extremely rare being described as anomaly, without any history of trauma, cardiovascular pathology or arteriovenous fistula. This clinical condition has a high rate of potentially fatal complications: pulmonary embolism; ruptured aneurism; deep vein thrombosis. There are only 7 cases of iliac vein aneurism described in the literature. We describe an additional case of a 59-year old patient presented with abdominal pain, right lower limb edema and palpable mass in the right iliac area. Ultrasound (US) revealed a liquid formation, confirmed by computed tomography (CT). Surgical removal of the aneurism with lateral venorrhaphy was performed. Postoperative evolution was uneventful. The patient is asymptomatic during 36 month follow-up.

[Bleeding gastric inflammatory fibroid polyp (Vanek's tumor)]. / Polip inflamator fibroid gastric (tumoare Vanek) cu hemoragie.

Inflammatory fibroid polyp's (IFP) or Vanek tumor of the gastrointestinal tract represents a relatively unusual entity. IFP is an extremely rare cause of upper gastrointestinal bleeding. We report herein a case of a 30-year-old woman who had a gastric IFP complicated by gastrointestinal bleeding and obstructive symptoms. The lesion was mistaken on endoscopic, radiologic examination and in the operating room for a gastrointestinal stromal tumor (GIST). Preoperative endoscopic examination revealed a protruding oval-shaped submucosal lesion (approximately 7 cm in size) of the gastric antrum, with ulceration of the mucosal surface. Multiple endoscopic biopsies were negative for neoplastic changes. Barium meal study disclosed a large tumor in the prepyloric area of the stomach. Presumptive preoperative diagnosis was GIST. Subtotal Bilroth II gastrectomy en bloc with the mass and lymphadenectomy was performed. Surprisingly, the final histological diagnosis was IFP. Postoperative course was uneventful and no recurrences were observed during 4 years follow-up. With reference to case report, the etiology, diagnosis and treatment strategy of IFP will be discussed. This case highlights an unusual presentation of IFP. Although bleeding may represent a rare complication due IFP, it should be considered in the differential diagnosis of upper gastrointestinal hemorrhage of uncertain etiology.

[Mesenteric cyst in the descending colon: a case report]. / Chist al mezocolonului descendent.

Mesenteric cysts are rare abdominal findings. The majority are asymptomatic and if found are discovered incidentally during ultrasonography and/or CT scanning. The optimal surgical treatment requires complete excision of the cyst. We report a case of 36-year-old woman with mesenteric cyst in the descending colon. Laboratory tests indicated no abnormality. Abdominal CT revealed a cystic mass in the retropreritneal space measuring 14.0 x 8.3 x 9.4 cm, density 26-29 HU. We found a cystic mass at the mesentery of the descending colon that was removed in toto. The authors discuss the symptoms and complications, classification, and treatment of mesenteric cysts with review of literature.

Ruptured duodenal varices successfully treated by mini-loop ligation: report of a case.

Bleeding from duodenal varices is a rare, but often fatal manifestation of portal hypertension and these ectopic varices are more common in extrahepatic portal venous obstruction. There are over 160 cases of duodenal varices reported in the English literature. A 47-year-old female presented with massive hematemesis and prolonged shock. Initial endoscopy revealed non-bleeding small esophageal varices and large varices in the first portion of the duodenum with spurting bleeding. Endoscopic hemostasis was obtained with 5 detachable nylon loops. Portal hypertension was caused by liver cirrhosis and postthrombotic portal cavernoma. To the best of our knowledge this is the first case of successful mini-loop ligation of bleeding duodenal varices reported in the literature.

[Carcinoid of the minor duodenal papilla associated with multiple jejunal leiomyomas in type 1 neurofibromatosis]. / Carcinoidul papilei duodenale mici asociat cu leiomioame jejunale multiple si neurofibromatoza tip 1.

Duodenal endocrine tumors are rare and represent 2% of all gastrointestinal endocrine neoplasms. Carcinoids of the ampulla of Vater are the most rare primary ampullary tumors. There was noted a frequent association of the endocrine tumors with type 1 neurofibromatosis also known as von Recklinghausen disease. To the best of our knowledge there are only 8 cases of papilla duodenalis minor carcinoids described in the literature. Authors describe herein the first carcinoid of papilla duodenalis minor case associated with multiple synchronic jejunal leiomyomas and von Recklinghausen disease, manifested with proximal intestinal obstruction and resolved by pancreatoduodenectomy (Kausch-Whipple procedure).

[Recurrent Crohn's disease in the ileocolonic anastomosis complicated with duodenal fistula]. / Boala Crohn recidivanta în anastomoza ileo-colica complicata cu fistula duodenala.

Duodenal fistulas in patients with Crohn's disease are rare, and up to one hundred cases were described in the medical literature. We report an additional case of a 40-year-old male who underwent an ileo-ascending colectomy 13 years ago for Crohn's disease and was admitted to our unit with palpable abdominal mass and persistent cutaneous fistula. Preoperative fistulography and barium enema demonstrated Crohn's disease recurrence in the site of the ileocolonic anastomosis and external fistula communicating with the pre-anastomotic ileum. At surgery, Crohn's disease recurrence in the site of ileocolonic anastomosis with ileo-cutaneous fistula was confirmed and an additional ileo-duodenal fistula was detected incidentally. The patient underwent resection of the affected bowel and simple closure of the duodenal fistula with omental pedicle graft transposition between the duodenum and the ileocolonic anastomosis. Postoperative period was uneventful. We review the literature and discuss the incidence and treatment strategy of duodenal fistulas complicating recurrent Crohn's disease in the site of the ileocolonic anastomosis. The authors highlight that simple closure of the duodenal defects is appropriate only for small duodenal fistulas and omental transposition between ileo-colonic anastomosis and duodenum during the primary and repeated resection should be considered as an effective prevention method of duodenal fistulas formation.

[Splenic abscess--etiologic, clinical and diagnostic features]. / Abcesul lienal--aspecte etiologice, clinice si diagnostice.

The aim of the study is to elucidate premorbid grounds, diagnostic and clinical peculiarities, as well as medical and surgical management of non-parasitic spleen abscess. We study 6 cases, with median age 56.7 years, men/women ratio--2:1. Onset-diagnosis period was of median 20 days. In 5 cases (83.3%) spleen abscess developed in immune compromised patients (diabetes mellitus, liver cirrhosis, pancreatitis) and in one case (16.7%) subsequent to blunt abdominal trauma. Clinically, patients presented fever, weight loss and pain in the left upper quadrant of the abdomen. The imaging data (USG, CT, and Rx-thoracic) performed prior to surgery confirmed the diagnosis. USG revealed splenic injury in 80%, CT had a 100% sensibility and thoracic Rx revealed left-side pleuro-pulmonary reaction in 83% of cases. Bacteriological test was positive in 50% of cases. One death was recorded in first 24 hours after surgery. The rest of the cases had a favorable evolution, although, in 2 cases a left subphrenic abscess was noticed, one requiring drainage; in one case--colonic fistula, which closed spontaneously. Although, it's a rare pathology, an early diagnosis is as important, as impossible, and it's delay exhausts the organism and increases the postoperative morbidity rate, splenectomy remaining the safest method of treatment.

[Intrabiliary rupture of the hydatic cyst complicated with acute pancreatitis]. / Erupere intrabiliara a chistului hidatic hepatic complicata cu pancreatita acuta.

Acute pancreatitis is a rare complication of hydatidosis, and only few reports were published previously. We report a case of a 17-year-old man, with recurrent liver hydatid cyst, who presented with severe upper abdominal pain, vomiting, jaundice. Amylase and bilirubin were elevated. Abdominal CT scan showed a cystic lesion in the dome of the liver and a diffusely swollen pancreas. At endoscopic retrograde cholangiopancreatography (ERCP) the common bile duct was dilated with fragments of hydatid membrane. A sphincterotomy was performed and hydatid membranes were extracted, after which the patient made an uneventful recovery and the level of amylase and bilirubin normalized. After two weeks a new episode of hydatid rupture occurred with clinical presentation of cholangitis. Emergency surgery was performed, which consisted of cystectomy, suture of intracavitary bile fistula, omentoplasty, choledochotomy with extraction of the hydatid membranes and common bile duct drainage. There were no relapses during 5 years follow-up. This case report highlights that ERCP and sphincterotomy are considered the procedures of choice in acute pancreatitis induced by biliary rupture of the hydatid cyst and surgical treatment is considered to be the only definitive treatment of the hydatic cystic lesion of the liver with intrabiliary rupture.

[Emphysematous necrotizing pancreatitis]. / Pancreatita acuta necrotica emfizematoasa.

The authors present an additional case of emphysematous necrotizing pancreatitis caused by Escherichia coli. Emphysematous necrotizing pancreatitis represents a rare and potentially life-threatening infection and is characterized by gas formation within or around the pancreas. A 26-year-old man presented with severe upper abdominal pain and vomiting, 7 hours from onset. Acute pancreatitis was initially diagnosed based on high amylase level, abdominal ultrasonography and primary CT scan. On the 7th day he developed fever, increasing abdominal pain and shortness of breath. On the second abdominal CT scan, the pancreatic bed was filled with gas. The diagnosis of emphysematous necrotizing pancreatitis was confirmed at laparotomy. The patient was treated successfully by extensive pancreatic necrosectomy, open packing and scheduled repeated debridements. Culture from the lesser sac, and retroperitoneal space, examined for aerobes and anaerobes, revealed growth of Escherichia coli. The authors analyze and discuss pathogenesis, diagnosis and treatment of emphysematous necrotizing pancreatitis. Based on the available data and this case, early surgical debridement and appropriate antibiotics appear to be the preferred treatment.

[Organized pancreatic necrosis resembling retroperitoneal tumor]. / Necroza pancreatica organizata simulând tumoare retroperitoneala.

This paper presents the case of a 29 years old patient who has an organized pancreatic necrosis, presenting preoperative differential diagnosis problems and surgical technique difficulties, revealing the fact that, in this particular case, paraclinical investigations have an orientative value, and are not offering information regarding etiology, and do not allow to establish a preoperative strategy. Tumor resection was performed; final diagnosis was established by histological examination. The follow-up period was uneventful.